The Academic Old Age Psychiatry Association (AOAPA) was established in 1998, with the aim of promoting and supporting academic activities and developments in this speciality. The members (currently 51) are old age psychiatrists with substantive university appointments, and others (both medical and non-medical) with substantial research and/or teaching roles in this area. An important objective of the AOAPA is to ensure that there is a section of old age psychiatry in all UK and Irish universities with undergraduate medical schools. To this end, a working party was set up with a remit to determine the current level of provision and identify important gaps; make recommendations regarding the necessary core staffing and resourcing of sections of old age psychiatry; and to make recommendations regarding the core undergraduate curriculum. In order to establish an up-to-date baseline, all UK and Irish undergraduate medical schools were surveyed in 1999 regarding their old age psychiatry establishment, and the undergraduate teaching that they provided in this speciality.

Method

Medical schools in the UK and Ireland (n=28) were divided into a provided group (n=15), where there was known to be an academic old age psychiatry establishment at senior lecturer level or above, and a non-provided group (n=13) where this establishment was absent (determined through AOAPA membership).

Results

In England and Wales, 14/19 (74%) of the schools had clinical academic establishment in old age psychiatry at the level of senior lecturer or above. In Scotland and Ulster, however, none of the schools had such an establishment. In the Irish Republic 1/5 (20%) of the schools were established at this level. The oldest academic grouping in this sample was established in 1978; the remainder were set up within the past 15 years.

Academic establishment and development: provided schools

The response rate to this questionnaire was 12/15 (80%). Table 1 sets out the current academic establishment in old age psychiatry (clinical and non-clinical) in the responding schools. Most schools had increased their numbers of academic staff in old age psychiatry since they were originally established; only one school reported attrition of a post because of lack of suitable applicants. Most academic old age psychiatry units were based in departments of psychiatry (8, 67%); alternative locations were in neuroscience (2, 17%), clinical sciences (1, 8%) and public health/primary care (1, 8%). All but two schools reported active research links between old age psychiatry and other academic departments. In all but one school the academic old age psychiatrists were involved in the organisation and delivery of undergraduate and post-graduate teaching in old age psychiatry, and 10/12 (83%) were involved in the organisation and delivery of undergraduate teaching in psychiatry more generally. In two-thirds of the schools, academic old age psychiatrists contributed to the undergraduate MBBS examination (or equivalent).

Table 1.

Current academic establishment (clinical and non-clinical) of provided medical schools

		Number of schools
	Number of posts	clinical	non-clinical
Professor	0	4	11
	1	7	1
	2	1
Reader	0	11
	1	1
Senior lecturers	0	2
	1	7
	2	2
	6	1
Lecturers	0	3	11
	1	9	1
Research fellows	0	9	10
	1	3	1
	3		1
Research assistants	0	8	8
	1	1	0
	2	2	3
	3	0	1
	6	1	0

Undergraduate teaching

The total number of responses to this questionnaire was 22/28 (79%): 15/15 (100%) from the provided schools and 7/13 (54%) from the non-provided schools. The replies are shown in Table 2. In all of the schools, the undergraduate curriculum contained some theoretical and/or clinical teaching of old age psychiatry, although in one case this was confined to a single lecture. The amount offered varied considerably, ranging from 1 to 40 days, with a mode of 4/5 days. In some of the schools, student exposure to old age psychiatry was variable, depending on individuals' clinical attachments. For the maximum a student could receive, the means were 10.8 days (provided schools) and 6.0 days (non-provided schools). A wide range of teaching formats were reported, the commonest in both provided and non-provided schools being the traditional methods of clinical attachments, lectures and tutorials. Other methods, such as demonstrations, computer-assisted learning, role-play and problem-based learning, were reported mainly by the provided schools. Only a minority of schools used work books or other documentation as part of their teaching, although a number reported that such materials were under development. A ‘core’ old age psychiatry curriculum of dementia, delirium, depression and psychotic disorders was taught by the majority of schools; service organisation was less commonly covered; and only the provided schools included subjects such as neurotic disorders, psychological treatments, cognitive assessment and ethical/legal issues in this age group. Student assessment was most commonly by formal examination and assessment of performance during the clinical attachment. Other techniques, such as assessed coursework and objective structured clinical examinations, were less frequently reported.

Table 2.

Undergraduate teaching of old age psychiatry in provided and non-provided medical schools

	Provided n (%)	Non-provided n (%)	Total n (%)
Teaching formats
lectures	11 (73)	5 (71)	16 (73)
tutorials/interactive	10 (67)	2 (29)	12 (55)
clinical attachments	13 (87)	5 (71)	18 (82)
other	5 (33)	1 (14)	6 (27)
Topic areas covered
dementia	15 (100)	6 (86)	21 (95)
delirium	15 (100)	6 (86)	21 (95)
affective disorders	14 (93)	6 (86)	20 (91)
psychotic disorders	12 (80)	6 (86)	18 (82)
service organisation	11 (73)	2 (29)	13 (59)
other	5 (33)	0 (0)	5 (23)
Workbooks/other	5 (33)	3 (43)	8 (36)
documentation
Student assessment
formal examination	10 (67)	5 (71)	15 (68)
coursework	3 (20)	4 (57)	7 (32)
clinical attachment	10 (67)	4 (57)	14 (64)
other	5 (33)	1 (14)	6 (27)

Six schools (provided: 3/15, 20%; non-provided: 4/7, 57%) reported that there had been significant obstacles to introducing and maintaining old age psychiatry teaching in the undergraduate curriculum. These included reduction of time available, insufficient academic or clinical staff, uncoordinated teaching across many modules and problems with colleagues in general psychiatry. Ten schools (provided: 5/15, 33%; non-provided: 5/7, 71%) said that they currently did not have any plans specifically to revise or expand their undergraduate teaching in old age psychiatry, although some of these commented that the whole of their medical curriculum was currently undergoing revision.

Discussion

This survey was planned as a comprehensive overview of current old age psychiatry teaching and academic provision for all medical schools in the UK and Ireland. The response rate to this survey was generally good, although there was a relatively poorer return from the non-provided schools. This may have been owing to the lack of a suitable respondent, or the lack of perceived salience of the questionnaires. Consequently, we may have underestimated the poorest end of the spectrum of academic provision and teaching in this speciality.

Several previous studies (Wattis & Arie Reference Wattis and Arie1981, Reference Wattis and Arie1984; Reference WattisWattis 1989; Reference Faire and KatonaFaire & Katona 1993; Reference Gregory and DeningGregory & Dening, 1995) have examined the point prevalence of academic posts in old age psychiatry and the practice of undergraduate teaching in this speciality in the UK. In comparison with these, our findings suggest there has been a considerable increase over the past decade both in the number of academic posts and in the amount of undergraduate teaching provided. For example, Faire and Katona (Reference Faire and Katona1993) reported a median proportion of psychiatry teaching devoted to old age psychiatry of 15% (range 2.5-25), with a median duration of 6 hours (range 1-14). The findings of the present survey are also better than those recently reported for Australia and New Zealand (Reference O'Connor, Clarke and PresnellO'Connor et al, 1999), where the mean length of old age psychiatry teaching was only 4.2 hours (range 0-7) out of a mean total of 353 hours (1.2%).

However, there is no room for complacency about the present state of academic old age psychiatry in the UK and Ireland. Just over half the medical schools that responded have established departments in old age psychiatry, and the academic establishment in these provided schools is patchy, for example, four departments do not have a chair. Three departments have no clinical lecturers in old age psychiatry, and these posts are likely to decrease further as the demands of the research assessment exercise result in cutting of posts that are seen as less productive in terms of publications and grant income. This is a worrying development, as lecturers represent the seed corn of the next generation of academics, and this survey has shown there is already a dearth of suitable applicants for some academic posts. Given the planned expansion in medical student numbers and the creation of at least three new medical schools in the UK over the next 5 years, the workforce situation nationally looks increasingly bleak. Some established academic sections of old age psychiatry might not continue to be viable if there is an insufficient critical mass of academics to sustain research output.

Because of demographic ageing, all doctors now need to have a good undergraduate training in the assessment and management of mental disorders in old age. Our findings show that those medical schools with established departments provide more teaching of old age psychiatry and are more likely to embrace new teaching methods. It is worrying that students in some medical schools may not be taught the fundamentals of dementia and delirium, although it is possible that this teaching may be provided elsewhere on their course.

At the postgraduate level, although old age psychiatry is now a major speciality within the UK, with 1512 members of the College Faculty of Old Age Psychiatry (539 consultants, including academics: figures as at 13/11/00), many consultant posts remain unfilled because of an inadequate supply of trained specialist registrars. Recent publications such as Forget Me Not (Audit Commission, 2000) and the National Service Framework for Older People (Department of Health, 2001) are likely to stimulate further development of the speciality. If this is to be driven by uniform excellence in teaching and research, then new ways will have to be found to encourage and train individuals in the subject. Both the NHS and universities need to recognise they have a role in fostering and financing the academic growth of the discipline. It would clearly be desirable for currently non-provided medical schools to set up sections of old age psychiatry, but once again the lack of suitably qualified applicants is likely to frustrate this in the short to medium term. However, it is important to demonstrate the need, and clinical old age psychiatry services associated with non-provided schools should be encouraging and supporting the development of NHS-funded academic posts.